Laparoscopic versus open distal gastrectomy for advanced gastric cancer in elderly patients: a propensity-score matched analysis

Background Scarce research has reported the efficacy and safety of laparoscopic distal gastrectomy in elderly patients. This retrospective study aimed to compare the outcomes of laparoscopic and open distal gastrectomy for advanced gastric cancer in elderly patients. Methods A total of 303 elderly patients who underwent distal gastrectomy for advanced gastric cancer from June 2017 to June 2021 were enrolled. Variables used to calculate propensity score matching included sex, age, body mass index, American Society of Anesthesiologists, history of diabetes, and history of hypertension. The statistical significance of continuous variables was tested using an independent sample t test. chi-square or Fisher’s exact tests were used for categorical variables. Kaplan–Meier curve and log-rank test were used for the evaluation of 3-year overall survival and recurrence-free survival. Results After performing 1:1 propensity score matching, 248 patients were included for analysis (laparoscopic = 124, open = 124). Compared with the open group, the laparoscopic group showed significant advantages in estimated blood loss ( P < 0.001), pain scale on the first postoperative day ( P = 0.002), time to first flatus ( P = 0.004), time to first liquid diet ( P = 0.005), hospital stays ( P < 0.001), and total complications ( P = 0.011), but devoted much more operation time ( P < 0.001). No statistical difference was observed between the two groups in 3-year recurrence-free survival ( P = 0.315) or overall survival ( P = 0.159). Conclusions Our analysis demonstrated that laparoscopic surgery had the advantages of less intraoperative blood loss, fewer postoperative complications, and faster postoperative recovery in distal gastrectomy for advanced gastric, indicating that laparoscopic distal gastrectomy is safe and effective for treating elderly patients with distal gastric cancer.